MANY ROUTES FORM PATH TO RECOVERY

Cancer can take a devastating toll on a patient’s physical and emotional health. But the good news is there are things cancer survivors can do to re-empower themselves.

Start back slowly: One thing that many cancer survivors don’t count on is the fatigue they feel long after their cancer treatments are finished. A general guideline is that for every month of cancer treatment, it will take a month to recover previous energy levels. In some cases it may take longer.

“You may need to have a talk with your employer or supervisor and ask if you can return to work slowly. If you normally worked eight-hour days, go back at four hours per day for the first couple of weeks, then six hours and then eight,” says Maureen Wallace, oncology clinical case manager for Sharp Memorial Outpatient Pavilion and a breast cancer survivor. “It’s better to ease back into work and build up endurance slowly.”

Redefine your new normal: Before cancer, maybe you were the quintessential supermom or the hard-driving sales executive, working long, stressful hours to be the best in your field. However, a serious illness can alter perspective and change priorities, and suddenly “doing it all” is no longer your motto.

“Don’t worry about trying to get back to exactly the same way you were before cancer. It’s OK that some things have changed,” says Kay Clark, health programs manager at the American Cancer Society of San Diego County and a breast cancer survivor. “Normal takes on a new meaning after cancer, and for a lot of people that new normal is better than ever.”

Join a support group: Support groups are an excellent way to connect and express what you’ve been feeling as a cancer survivor. Even though family and friends try to understand and be supportive, if they’ve never had cancer, it can be difficult for them to relate.

“I joined a support group because it gave me an environment where I could be angry or sad if I wanted to. I could make jokes about my cancer that some people may have thought were in bad taste, but the people in the support group understood and found the humor,” Clark says. “A support group can be a safe environment in which you can talk about anything. Your fears, depression, anger, all of these things need to be addressed.”

You may need to go to several support groups, trying them out until you find one that’s a good fit for you. When possible, joining a support group of people with your same type of cancer can help you better understand certain problems that are inherent to particular kinds of cancer.

Support groups are also a great place to exchange ideas, information and resources.

“It can be uplifting to see that people have coped with surgery, radiation and chemo and they’re making it. It can be helpful to learn how they did it,” Clark says.

Write your thoughts: A support group with live interaction isn’t for everyone. Some survivors prefer the more private, introspective approach of journaling.

Cancer survivor Mario Duran of Vista found that writing down what he was feeling after his cancer treatments were over helped him “get the anxiety out of my system,” he says.

A Scripps Clinic cancer survivor support group, When Words Heal, combines journaling with the more social aspects of a support group, and has participants write their thoughts and emotions and then take turns reading them aloud to the group, if they wish.

“Sharing and comparing our experiences like that was really good. We were able to help each other,” Duran says.

Professional counseling: Dr. David Leopold, integrative medical specialist at the Scripps Center for Integrative Medicine, recommends professional counseling for all cancer survivors.

“Cancer is very stressful not only for the patient but also for the caregivers and family. They need some kind of outlet,” he says, noting that it’s helpful to seek out therapists who specialize in treating cancer patients.

Depression is very common for cancer survivors, Wallace explains.

“As a cancer survivor you’ve suffered a loss. When you lose a part of your body, you go through a grieving process,” she says.

Talk frankly with your doctor: Ask your doctor about what you can do to reduce your risk of a cancer recurrence.

Ask about any symptoms or signs that concern you. Ask about your risk of recurrence and what symptoms to watch for. Ask what to do if you experience these. Get the facts so you can feel more in control. Don’t let your fears keep you from follow-up appointments.

Exercise: “I really like to get cancer survivors exercising regularly. It’s proven that exercise improves overall health and decreases cancer recurrence,” Leopold says. “Exercise gets them up and out. It gets them back in control of their body.”

He highly recommends strength training and weight lifting when cancer treatments are finished.

“It puts muscle mass back on and empowers them. It makes them feel good about themselves,” he says, adding that it’s important to train, at least at the beginning, with a professional fitness trainer who has had experience working with cancer survivors.

“Yoga offers a mind, body, spirit (exercise) for the whole package that’s been assaulted. It’s not just your body that went through cancer, but also the mind,” she says. “Yoga allows us to slow down and be aware of our bodies. It gets us back into connecting our physical bodies with our spirit and our mind.”

Diet: Eating a healthful diet is especially critical for people who have had cancer.

“It’s empowering to control what goes into the body, especially after you’ve had cancer,” Leopold says. “(Survivors) need to get their diets cleaned up. There’s no room for junk food or things like processed meat, which we know contributes to cancer.”

Stress management: Formalized stress management techniques such as biofeedback, deep breathing or meditation can be beneficial to relieve some of the anxiety after cancer treatments.

Alternative complementary therapies: After his cancer treatments, Duran felt nervous and found it difficult to relax. For him, acupuncture was the answer.

“I guess I was just thinking about the cancer so much. The tension was giving me headaches,” he says. “They put needles in my neck, back and legs, and it really helped relieve the tension and the headaches. My body was much less stiff.”

Other complementary therapies such as guided imagery, healing touch and massage can help calm the mind and body.

R.J. IGNELZI

Fran Arter kicked off her shoes, stretched out on her mat and closed her eyes. Within minutes of entering the Yoga for Cancer Survivors class, the tension in her face melted into a look of serenity.

“This class is my chance to take a vacation from the mental circus in my head,” says the 57-year-old breast cancer survivor from Bay Park who regularly attends the Wednesday morning class at the Hazard Center YMCA.

After three months of chemotherapy following surgery, she couldn’t wait to finish her treatments and be declared cancer-free. She thought her worries would be over. However, 18 months since her last chemo treatment, her body is healing, but her state of mind has a ways to go.

Scheduled for a follow-up scan with her oncologist in one week, Arter says she’s “already feeling anxious about returning there. It’s on my mind from the time I wake up in the morning. I know they’re looking for something, and I’m just hoping they don’t find it.”

Unfortunately, the stress of the disease doesn’t necessarily end with the chemotherapy. There are nearly 12 million cancer survivors in the U.S., according to the National Cancer Institute, and every time they have a scan, MRI or X-ray, they can be on pins and needles for weeks before the appointment. Every minor ache, lump or bump can cause a survivor to worry about recurrence.

“For the first couple of years (after cancer), you’re wondering things like, ‘Could that little mole be skin cancer?’ ” says Kay Clark, health programs manager at the American Cancer Society of San Diego County and a 17-year breast cancer survivor. “Given what cancer patients have been through, that kind of fear is normal. But you have to try to give it a dose of reality.”

Former cancer patients are often expected to bounce back into their old routines as if normalcy returns as readily as a head of hair. But it’s more complicated than that.

“You have one thing in mind when you’re sick. That’s getting well. At the end of my treatment, after surgery and six months of chemo, when I was feeling completely depleted and needing some guidance, my doctor said, ‘OK, just go on with your life now,’ ” says Jean DiCarlo-Wagner, colon cancer survivor and Yoga for Cancer Survivors instructor. “I had a lot of fears and questions. Even though the numbers said I was clear (of cancer), I didn’t feel like myself.”

After months of relying on doctors, nurses and technicians to examine, treat and monitor patients to make them well, suddenly their health is once again their own responsibility. That can be scary and more than a little stressful.

“The support they’ve had for months is gone and now they’re alone with their thoughts and worries. That’s often when they need more support than ever before,” says Maureen Wallace, oncology clinical case manager for Sharp Memorial Outpatient Pavilion and a breast cancer survivor.

Our health system focuses on curing the patient of cancer, but nobody is there to help people make the transition from patient to survivor.

“Once someone is diagnosed with cancer, they enter a whirlwind of medicine. But while we are amazing at keeping people alive, we fall short in caring for overall health,” says Dr. David Leopold, integrative medical specialist at the Scripps Center for Integrative Medicine. “Once the disease has been managed, most doctors don’t have the time or training to manage the stress that people feel once they’re through with the treatment process.”

Along with the emotional baggage that comes with the illness, some cancers and treatments may cause physical changes that can lead to self-consciousness and sometimes prompt stress and depression.

“You may be done with chemo, but you’re left with no hair. As good as reconstruction is after a mastectomy, many women just don’t see themselves as the same person,” Wallace says. “You may be in remission, but you have a constant reminder about your cancer every time you look in the mirror.”